A dental surgical unit for the mentally handicapped.

Function Its purpose was to treat patients whose degree of subnormality was such that operative procedures with local anaesthesia and sedation would be difficult and rarely successful. Full general anaesthesia with endotracheal intubation and throat pack made it possible for the most intractable patient to have the necessary treatment completed in one visit. The theatre is equipped with all the necessary apparatus and instruments for minor oral surgery. (Whitehead, 1971).


Introduction
In August 1970 a General Anaesthetic Unit, on the lines of a minor operating theatre, was established at Stoke Park Hospital, Bristol.

Function
Its purpose was to treat patients whose degree of subnormality was such that operative procedures with local anaesthesia and sedation would be difficult and rarely successful. Full general anaesthesia with endotracheal intubation and throat pack made it possible for the most intractable patient to have the necessary treatment completed in one visit. The theatre is equipped with all the necessary apparatus and instruments for minor oral surgery. (Whitehead, 1971).

Theatre Staff
A Sister-in-Charge and a Staff Nurse, both experienced in operating theatre procedures, are in attendance during sessions. An experienced consultant from a neighbouring hospital anaesthetises the patients.

Pre-Operative Care of the Patient
The medical staff and the consultant anaesthetist assess the fitness of patients for general anaesthesia.
The anxiolytic and central muscle relaxant drug diazepam (Valium) has proved to be excellent in the preanaesthetic control of the restless and apprehensive subject.
Antibiotics are used selectively?mandatory in all cases of congenital and other cardiac defects.

Recovery Room
A nurse who has received instructions from the consultant on the care of the unconscious patient remains on duty throughout the session. The recovery room has all the necessary apparatus and drugs for resuscitation. In all cases post-anaesthetic and post-extraction recovery has been uneventful.

Operative Procedures
Strict theatre asepsis is maintained. Dental treatment for this category of patient would of necessity be limited in scope:?
(2) Surgical removal of unerupted impacted third molars to avoid the painful inflammatory stages of pericoronitis. A mobile x-ray apparatus is available to aid diagnosis. (3) Gingivectomies are performed to remove chronic hyperplastic gingival masses from patients who are receiving the drug phenytoin sodium for the control of epilepsy.

Mongolism
Invariably the lower incisors, in particular, become loose due to irreversible chronic periodontitis. Early removal of affected teeth prevented the spread of infection to posterior teeth in the mandible. 19 males and 9 females received treatment.
Abnormalities of oral cavity and dentition predominantly microstomia, macroglossia, high narrow palate and dry fissured lips. There was a noticeable degree of skeletal Class III classification of occlusion. There were cases of partial anodontia, supernumerary teeth and retained deciduous teeth. Morphologically the anterior teeth were small and shovel-shaped and the crown of the small molars and premolars had illdefined cusps. There were several cases of enamel hypoplasia. (Swallow, 1964 The high narrow palate had ill-defined thick asymmetric pattern of the palatine rugae. Alginate impressions were taken prior to extractions to preserve permanently plaster models of the dentition of this rare case. (Jancar, 1962).

Porphyria
All patients requiring treatment under full general anaesthesia are screened. Sedative drugs containing barbiturates and their derivatives are strictly contraindicated in positive reactions. One female and one male were treated. The teeth showed a red-brown discolouration.

XXXXY Syndrome
A male of 26 years had 4 carious teeth removed.
A transalveolar resection technique had to be adopted, the x-ray films having shown abnormal root curvatures with conflicting lines of withdrawal.

Summary
The formation and the functioning of a Dental Surgical Unit has been described. A noteworthy result of treatment was the reports from nursing staff of improved general health and behaviour amongst patients who were relieved of dental pain and sepsis. Up to the present time 322 patients have received radical treatment for the elimination of grossly infected teeth and the correction of congenital dental defects. The chronological age ranged from 7 to 64. Average I.O.